Date

Owner's Name *

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Phone *

Pet's Name *

Species

Breed

Sex

Age

Color

I, the undersigned, hereby state that I am the [legal owner/legally authorized representative of the legal owner] of the above listed pet and authorized to make all medical decisions regarding this pet. I have declined any further care for the above pet and am hereby authorizing Family Pet Health to euthanize the above listed pet. *

I have read, understand, and authorize.

I agree to have Family Pet Health choose a euthanasia protocol at their sole and exclusive discretion and have had all my questions and concerns regarding this process answered prior to signing this consent. I attest that the above listed pet has not been exposed to rabies, has not bitten anyone, and has not displayed any signs of unusual attitude or aggression in the last 15 days. *

I have read, understand, and authorize.

It is my desire to provide for my pet decent and humane after-death care, complying with all legal requirements of the area. I authorize Family Pet Health to take charge of my pet's remains in accordance with hospital policy, releasing the staff from any and all liability for performing said after-death care. *

I have read, understand, and authorize.

I request that this animal's remains be cared for in the following manner: *

Private cremation with return of ashes. I wish to have my pet individually cremated offsite.
Cremation with no return of ashes. My pet's remains will not be returned to me.
Home burial. I wish to take my pet's body home.

Signature *

I am the owner or the authorized agent for the owner of the animal described above, and I have the authority to execute this consent. My signature above certifies that I am over eighteen years of age.

Consent for Euthanasia

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